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More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that faults Medicare for failing to enforce a federal law requiring immediate notification. The Health and Human Services inspector general's office issued an "early alert" Monday on preliminary findings from a large sampling of cases in 33 states, reports the AP. Auditors—who scoured hospital, nursing home, and billing records—identified 134 cases spanning 2015 to 2016 in which emergency room records indicated possible sexual or physical abuse, or neglect. In 28% of the cases, investigators could find no evidence in hospital records that the incident was reported to local law enforcement.

That's despite a five-year-old federal law requiring nursing homes to report such incidents to police and other agencies, or risk fines of up to $300,000. In one case involving an alleged sexual assault reported to police by a patient's family, a nursing home actually "contacted local law enforcement in an attempt to keep law enforcement from investigating the incident," the inspector general's report said. A nursing home industry trade group says its members know they must immediately report alleged abuse. The American Health Care Association adds it will work with the government to ensure safety. In a statement, Medicare emphasized that nursing home safety is a high priority, but it said it will await a complete report before announcing a response. (Read more nursing homes stories.)